Provider Demographics
NPI:1083632756
Name:VILLAMOR BALLECER, MELISSA (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:VILLAMOR BALLECER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8088 W WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-6564
Mailing Address - Country:US
Mailing Address - Phone:602-344-5287
Mailing Address - Fax:
Practice Address - Street 1:950 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1506
Practice Address - Country:US
Practice Address - Phone:623-344-6809
Practice Address - Fax:623-344-6882
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice